On December 10, 2004, the Center for Health Care Strategies convened a meeting on the use by states of purchasing levers to support better implementation of evidence-based practices in the treatment of substance-use disorders.

States are the largest purchasers of treatment services and therefore will play a central role in improving treatment quality.

Key Results

The meeting explored:

Existing Models

• The initial Center for Health Care Strategies/Legal Action Center research concluded that there are few if any good models of the effective use by states of purchasing levers specifically to support evidence-based practices. However, a small number of states have begun to experiment with giving financial incentives for performance on certain indicators.

Potential Incentives to Promote the Use of Evidence-Based Practices.

• States are using — or are exploring using — different types of incentives to promote the use of evidence-based practices in substance-use disorder treatment. Participants at the meeting described five such types:
• Financial payments (pay-for-performance).
• Relief from regulatory requirements.
• Allowing an advantage in a competitive bidding process.
• Providing infrastructure support (including free training in evidence-based practices).
• Recognition for providing evidence-based care.

Challenges to the Use of Purchasing Levers.

• There are four main categories of challenges to effective state use of evidence-based practice purchasing levers:

1. leadership for change
2. coordination and cooperation among providers
3. financing
4. training/technical assistance in the use of evidence-based practices.

Funding

The meeting was sponsored by the Robert Wood Johnson Foundation (RWJF) with a grant of $79,958 as part of its current focus on improving the quality of substance-use disorder treatment.